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I've been having CBT.  My therapist asks me a lot of questions and I answer them.  I fill out lots of worksheets.  That's CBT? I don't follow how answering questions about my OCD and filling out worksheets about my OCD is helping to alleviate the problems.... Help!

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CBT is meant to teach you how to deal with your thoughts in a more positive way so they don't effect your every day life. It's taking your thought,  learning to live with them but not react to them.

If you find you aren't getting anywhere with your therapist then please change to another one. OCD needs to be tackled head on in order to recover.

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2 hours ago, seekingERPnorthwest said:

I've been having CBT.  My therapist asks me a lot of questions and I answer them.  I fill out lots of worksheets.  That's CBT? I don't follow how answering questions about my OCD and filling out worksheets about my OCD is helping to alleviate the problems.... Help!

Is this an IAPT service?

The questionnaires are for their reporting, which is important in some respects so we can see whose being helped and whose not, but I personally always made the point I am happy to fill them in, but before or after therapy, not during the actual session (so not to take my therapy time).

Asking questions is part of the therapists job to help them understand you and your problems, and should be the way the first couple of sessions perhaps pan out, but beyond that the session should be about looking at solutions for the problems, talking about what we think and why and discussing alternative ways to think, and then collaboratively agreeing ways to challenge some of those thought processes. 

 

 

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Thanks as ever, Ashley.  No, it's MIND.  Yes I understood that the first couple of sessions would be like an assessment, with the therapist asking me questions to find out about me, but I've had 9 sessions now.  I don't know how to challenge my thought processes but it's very useful to know that that is what I could / should be trying

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2 hours ago, seekingERPnorthwest said:

No, it's MIND

MIND do run some IAPT services though (I get the impression OCD is not their strong point!).   By the sounds of it you have sadly gone through a typical IAPT course of treatment with some therapist box ticking rather than making therapy patient focussed. I would talk to your GP about alternative ways to access CBT locally.

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*This is my own personal point of view

I am not the biggest fan of CBT as being the sole answer to anyone's problems.

In my view CBT is like cutting the top of a weed, eventually it will grow back or is managed to low levels.

Its my view that CBT can reduce your levels of OCD and will help manage your thoughts etc, however I personally don't think it will really fully deal with the core or root.

Core self is pretty much where the root of OCD will come from or indeed any incongruence or problems people would seek therapy.

CBT is offered and used mainly because its cheap (only about 8 sessions), effective in the short term (will help reduce effects) and its practical (i.e. you do most of the work outside the sessions.

Its my view that therapy that would look at core self, looking at the root, alongside CBT, or any other counseling or therapy would be even more effective.

A CBT therapist can only guide you in the right direction, as I said it only really has any effect if you do most of the work i.e. worksheets etc

PLEASE NOTE, THIS IS JUST MY OPINION!!

 

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43 minutes ago, Jimmy1976 said:

*This is my own personal point of view

As you say... just your view.  More or less all of it wrong I am afraid, but as you go to great pains to suggest, just your view.

At the risk of going off topic I will offer a rebuttle.   I am not sure if your view is shaped by poor experience, if so then I am sorry you have gone through that. But if your view is offered based on your belief about treating OCD then I think that may be why you fail to get the purpose of CBT.

43 minutes ago, Jimmy1976 said:

CBT is offered and used mainly because its cheap (only about 8 sessions), effective in the short term (will help reduce effects) and its practical (i.e. you do most of the work outside the sessions.

Please don't confuse IAPT with CBT.    CBT is not cheap when you take into account all the training a therapist must (or should) undergo.   A course of CBT is not 6 or 8 sessions, it should be whatever is needed 10-30 sessions not unusual outside of IAPT.   But CBT is meant to be a short term solution that helps a patient become their own therapist, which when applying correctly on a regular basis can help someone overcome their OCD (not just effects).

Compare that to counselling or other talking therapies which are designed to spend forever and a day talking about feelings and trying to investigate deep seated roots, which won't treat OCD even if you do discover them, then I suppose CBT is cheaper.  It's more effective because it's designed to be shorter term deliberately, and if short term it's cheaper. But it's cheaper because it's more effective compared to other forms of talking therapy.

 

48 minutes ago, Jimmy1976 said:

In my view CBT is like cutting the top of a weed, eventually it will grow back or is managed to low levels.

 Personally, I believe CBT (when done right) allows us to kill the weed and allow flowers (pleasant thoughts) to take over that space left by the weed.  

 

1 hour ago, Jimmy1976 said:

Core self is pretty much where the root of OCD will come from or indeed any incongruence or problems people would seek therapy.

This makes no sense, it's just words.  

 

50 minutes ago, Jimmy1976 said:

Its my view that CBT can reduce your levels of OCD and will help manage your thoughts etc, however I personally don't think it will really fully deal with the core or root.

Bad CBT yes.  Good CBT no.  Here I can't help thinking you're confusing behavioural therapy with cognitive behavioural therapy.     To treat OCD we don't look for a cause, even if you find it, it usually it won't help resolve the problem here and now, and that's what CBT does it treats the problem not the cause (root or core).   CBT is not about 'managing' thoughts in the sense you mean, we don't just carefully guide thoughts into a gentle area of our brain with therapy, it is about changing a person's response to their thoughts, so that the thoughts themselves eventually cause no anxiety at all and changing a persons behaviour to the thoughts.

 

56 minutes ago, Jimmy1976 said:

A CBT therapist can only guide you in the right direction, as I said it only really has any effect if you do most of the work i.e. worksheets etc

This is the only part I agree with. A good therapist is our educator but ultimately only our guide, the hard work must come from us. Analogy wise,. a therapist is like a driving instructor, they can sit next to us, teach us, advise us, but we ultimately control our journey.  Although to be clear CBT is not about worksheets, I don't think OCD specialists really use them much in therapy itself. I have never ever used a worksheet when applying my CBT.

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CBT is a behavior therapy hence the name. (indeed all therapy is about behavioral change).

CBT is relatively cheap compared to training someone in psychotherapy.

I am not confusing IAPT with CBT at all. CBT is aimed at short term here and now, is less concerned about past or feelings. Sessions for most people do not last much for than 10. Anymore sessions (in my view) would suggest the CBT therapist is only re visiting the work already done.

You simply cant just deal with thoughts without addressing feelings, hence why core self is important when supporting people to make change.

Personally, I don't believe in "one size fits all" approaches to therapy.

CBT will work for many people, but not all, you could say the same with Psychotherapy, DBT, NLP or any other therapy.

 

 

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Core beliefs, kind of make up your core self anyway.

My point is what you think and feel about self is very important and cant be taken away or ignored when supporting someone to change. All therapy has the same end goal which is behavior change.

I just don't think one size fits all when it comes to what therapy you choose. Research has shown CBT to be effective, however recent research says its loosing its effectiveness, newer therapies are coming through which focus more on your beliefs and the thoughts you have around them. There are some researchers who suggest that certain therapies "have there time" then something else comes along.

There is no "one way" to treat or help people with OCD or any mental health issues. In my experience of working with people for nearly 20 years is the working relationship, bringing hope and believing people can change. 

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9 hours ago, Jimmy1976 said:

CBT is a behavior therapy hence the name. (indeed all therapy is about behavioral change).

No, it's COGNITIVE behaviour therapy.  Not 'just' behaviour therapy. 

 

9 hours ago, Jimmy1976 said:

CBT is relatively cheap compared to training someone in psychotherapy.

How do you figure that?  Not sure I agree but I am not going to debate the point.  But it's irrelevant for OCD discussion because generally psycho analytic type of therapy is shown to be generally unhelpful for OCD.  Approaches to OCD which focus mainly on causes have not been found to be even slightly effective.  

 

9 hours ago, Jimmy1976 said:

I am not confusing IAPT with CBT at all. CBT is aimed at short term here and now, is less concerned about past or feelings. Sessions for most people do not last much for than 10. Anymore sessions (in my view) would suggest the CBT therapist is only re visiting the work already done.

You really don't seem to have a very good understanding of this at all Jimmy. CBT and IAPT are two different things, and I generally feel the CBT conducted within an IAPT setting is often of very poor quality in far too many instances.  But, when done correctly CBT can be highly effective, and for some people that will involve a dozen sessions or several dozen sessions. 

You're right, CBT looks at the here and now, to use your analogy it does deal with the weeds. There is no point something which tries to deal with the roots if that leaves the weeds untouched! 

9 hours ago, Jimmy1976 said:

You simply cant just deal with thoughts without addressing feelings, hence why core self is important when supporting people to make change.

CBT, when done properly, includes taking account of the history and development of the problem, and in some instances this is important for the way CBT is conducted. CBT as a psychological approach has a range of robust evidence for its efficacy in terms of RCTs and meta-analyses. 

Clearly you are anti-CBT and that is absolutely fine, but your spouting a lot of nonsense which goes against the evidence, and could be disruptive and unhelpful to people about to being therapy with CBT.

9 hours ago, Jimmy1976 said:

CBT will work for many people, but not all, you could say the same with Psychotherapy, DBT, NLP or any other therapy.

I agree that CBT may not help everyone, but often for many of those people my gut feeling is it's not CBT failing them, it is the therapist and their lack of knowledge.  There may be the odd person helped by other approaches, of course that will always be the case.   But the fact remains CBT is the best evidence based treatment we have right now, and there's plenty of evidence to show that the majority of those other therapies you list won't be effective. 

7 hours ago, Jimmy1976 said:

Research has shown CBT to be effective, however recent research says its loosing its effectiveness, newer therapies are coming through which focus more on your beliefs and the thoughts you have around them. There are some researchers who suggest that certain therapies "have there time" then something else comes along.

Generally people saying these things have their own hidden agenda.  A therapy can't just lose its effectiveness, what a silly thing to say. I would agree that the quality of therapists training and clinical support is an issue that will impact on therapy, but that's totally different than suggesting a therapy can lose effectiveness. 

People accuse me of being Pro-CBT and closed to other alternatives. The fact is I have been doing this longer than many of you have had OCD and I have seen people try all sorts of therapies over the years, generally most report it does not help them, and some that say it did are back to me within months saying they are still suffering. So right now, I am Pro CBT because it works (when done right).  

If one day another therapy is shown to be even more effective for the treatment of OCD then I will become Pro that, but right now we are not at that point.

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I perfectly know and understand iapt services. I fully understand how cbt works it's theory and practice. I'm pro choice, cbt is one of many therapies that help. It's still ends up in behaviour change like any other therapy. There has been many studies and research in to long term effects of cbt and many other therapies tbh who cares, people just want to feel normal or better whatever you want to call it. Whether it's cbt, nlp mct, psychotherapy, person centred so on and so on the end result is what people want. Your clearly a cbt fan and that's great, doesn't give you a right to shoot down anyone else from suggesting alternatives. You might have been doing whatever it is for longer than people have had ocd, that doesn't mean you or anyone (including myself) have the answers. 

Btw therapy can loose it's effectiveness, or should I say relevance. Lots of research on that....but I guess they have a hidden agenda.

Thanks for your comments, I won't post anymore on this.

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2 minutes ago, Jimmy1976 said:

I'm pro choice, cbt is one of many therapies that help.

That help OCD?  I am still struggling to think of anybody I have come across over the years who have been helped to reach recovery by using anything but CBT (some with meds, some without). 

I am not trying to shoot down other alternatives, I am simply responding to your 'views'. 

 

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If other therapies had been spectacularly successful specific to OCD, then the news would have been shouted from the rooftops, worldwide. 

But I think there has been a deafening silence. 

CBT has not stood still - it has been an evolving method, and also other concepts have been found beneficial as adjuncts to CBT - noticeably "The Four Steps"  from the book "Brainlock"  and Mindfulness. 

Edited by taurean
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Just to reiterate that Jimmy got it wrong twice when he said CBT is meant to change a person's behavior, as if that is the only thing going on. The C stands for Cognitive and that wholly other therapy is all about changing the way sufferers think.

Edited by PolarBear
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On 23/06/2017 at 23:17, Ashley said:

 CBT and IAPT are two different things, and I generally feel the CBT conducted within an IAPT setting is often of very poor quality in far too many instances. 

Hi, I was just wanting to check, in the stepped care system, won't the majority of people's routes to treatment be via IAPT as one of the first interventions though?  Please could you run through the other (better quality) settings where you can get CBT?

https://www.england.nhs.uk/mental-health/adults/iapt/ says "The Improving Access to Psychological Therapies (IAPT) programme began in 2008 and has transformed treatment of adult anxiety disorders and depression in England. [...] IAPT services provide evidence based treatments for people with anxiety and depression (implementing NICE guidelines)."

They are "delivered by fully trained and accredited practitioners, matched to the mental health problem".

So, if it's frequently poor quality, what can we / could we do about it?  The website says they want to expand it...

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12 hours ago, seekingERPnorthwest said:

Hi, I was just wanting to check, in the stepped care system, won't the majority of people's routes to treatment be via IAPT as one of the first interventions though?  Please could you run through the other (better quality) settings where you can get CBT?

Don't get me wrong. There are some great IAPT therapists, but it is patchy and I fear they are in the minority.  In some parts of England the IAPT (primary) and secondary care service is run by the same NHS Trust. So there is frequently a good pathway between the two.

If a patient feels IAPT is not going to be appropriate for them, then you can speak to the GP about referring you to secondary care services, and see if you can bypass IAPT. But usually, the route is IAPT > secondary care services.

What we do to improve IAPT training?  This is where it gets political and hard, but we can all play a part by feeding back poor experiences to the charity, to NHS England, in complaints to local service commissioners. 

 

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